title: The influence of dispositional optimism on decision regret to undergo major breast reconstructive surgery.
abstract: OBJECTIVE
  It is not known if optimism influences regret following major reconstructive breast surgery. We examined the relationship between dispositional optimism, major complications and decision regret in patients undergoing microsurgical breast reconstruction.
  
  
  METHODS
  A consecutive series of 290 patients were surveyed. Independent variables were: (1) dispositional optimism and (2) major complications. The primary outcome was Decision Regret. A multivariate regression analysis determined the relationship between the independent variables, confounders and decision regret.
  
  
  RESULTS
  Of the 181 respondents, 63% reported no regret after breast reconstruction, 26% had mild regret, and 11% moderate to severe regret. Major complications did not have a significant effect on decision regret, and the impact of dispositional optimism was not significant in Caucasian women. There was a significant effect in non-Caucasian women with less optimism who had significantly higher levels of mild regret 1.36 (CI 1.02-1.97) and moderate to severe regret 1.64 (CI 1.0-93.87).
  
  
  CONCLUSIONS
  This is the first paper to identify a subgroup of non-Caucasian patients with low dispositional optimism who may be at risk for developing regret after microsurgical breast reconstruction. Possible strategies to ameliorate regret may involve addressing cultural and language barriers, setting realistic expectations, and providing more support during the pre-operative decision-making phase.
authors.affiliation: Division of Plastic & Reconstructive Surgery, Breast Restoration Program, University Health Network, Toronto; Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto.
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
authors.forename: Shaghayegh
authors.initials: S
authors.lastname: Bagher
authors.forename: Kunaal
authors.initials: K
authors.lastname: Jindal
authors.forename: Delong
authors.initials: D
authors.lastname: Zeng
authors.forename: Anne C
authors.initials: AC
authors.lastname: O'Neill
authors.forename: Sheina
authors.initials: S
authors.lastname: MacAdam
authors.forename: Kate
authors.initials: K
authors.lastname: Butler
authors.forename: Stefan O P
authors.initials: SO
authors.lastname: Hofer
authors.forename: Andrea
authors.initials: A
authors.lastname: Pusic
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Metcalfe
mesh_terms: D050153:Abdominal Fat / Q000637:transplantation; D000328:Adult; D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000208:ethnology / Q000601:surgery; D003657:Decision Making; D004644:Emotions; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods*; D008866:Microsurgery; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data*; D013524:Surgical Flaps / Q000098:blood supply; D013694:Temperament; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: autologous abdominal tissue; decision-making; ethnicity; outcomes; psychosocial; reconstructive microsurgery